Claim total
$219.95
base $93.39 · payer covered $169.95
The visit
- Class
- Ambulatory
- Code
- 390906007
- Reason
- diagnosis concept Hyperlipidemia55822004
- Start
- 2019-04-21
- Stop
- 2019-04-21
The parties
- Patient
- patient Santa Antonina Bernier
- Provider
- provider Jack Boehm
- Care site
- care site ALLINA HEALTH SYSTEM
- Payer
- payer Medicaid
Record id
051f1153-ae45-1425-31a9-f12f1f407204